A 51-year-old woman without chronic degenerative diseases, allergic to penicillin, and with positive surgical history for two cesarean sections and bilateral tubaric occlusion.
It has been precipitated from a height of 3 m above the right heel, as a result of which he suffered a fracture of the heel which was treated by Traumatology and Orthopedics by open reduction with internal fixation.
Four weeks after surgery necrosis of the skin cover of the lateral inframaleolar region of the affected foot appeared.
At the time of exploration (28 days since fracture reduction), we observed the presence of a tapered tapered tissue with exposure of the fixation system and calcaneus of approximately 4 cm horizontally.
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The patient underwent surgery 7 days later in collaboration with the Traumatology and Orthotic Surgery Service, which removed osteosite material (placas and to digitimiis internal flap fixation muscle), and performed the reconstruction of internal fixation material.
Surgery was performed under epidural block without ischemia.
For the flap, we performed first debridement and surgical debridement of the affected area; extended S incision distally on the lateral edge of the foot at the level of the 5 metatarsal muscle, exposing
Dissection of the calcaneus in a retrograde direction until finding the location at the level of the distal plantar edge of the calcaneus.
The defect was closed in three planes with absorbable monocryl 3-0 suture.
The flap rotation was 180 degrees, with a length of approximately 8 cm, and dimensions of 10 cm long by 2 width.
We stretched the muscle as a fan to provide the greatest coverage possible, and fixed it to the rest of the upper and lower edges of the defect with absorbable 3-0 monocryl suture, after checking the viability of the flap.
Finally, we take a thin partial thickness graft of 12 thousandths of inches from the lateral region of the cleft with dimensions of approximately 5x5 cm, applying it to cover the wound dressing.
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The patient was discharged 48 hours after the procedure, with an appointment for revision and cures in the outpatient clinic at 5 days.
At this time, we removed the graft anchored dressing in good conditions, so we continued treatment without covering with ointment, gauze or dressings to allow aeration.
Five more revisions were carried out in the outpatient clinic, in which we performed cures with superoxidized water solution, sodium chloride (Cln), hypochlorous acid (HOCl) and hypochlorite).
After verifying the viability and survival of the flap, the patient was referred to the Orthopedics Department four weeks later for rehabilitation and control.
Location fixed determined the correct consolidation of the fracture site at the time of removal of the internal fixator, so a new fixation of the fracture site was not necessary.
The patient remained seated for 4 months in rehabilitation to achieve complete ambulation.
